My research agenda seeks to develop a scorecard of neonatal intensive care unit (NICU) quality. Background: Interest in comparative quality measurement and evaluation has grown considerably because of recognition of the widespread variation in clinical practice, increased availability of evidence about medical effectiveness, and increasing concerns about the cost and quality of healthcare. In other fields of medicine, scorecards of performance have improved the quality of healthcare institutions, providers, and patient care. Specific Aims: I seek a K23 award to develop into an independent investigator and to become expert in the measurement of the quality of neonatal healthcare. Specifically, I propose to develop a scorecard of neonatal intensive care quality for very low birthweight infants (less than 1500 grams). Aim 1: To select measures for inclusion in the scorecard of NICU quality of care Aim 2: To construct a scorecard and rank NICUs according to their performance Aim 3: To evaluate NICU rankings in response to alternative methods of scorecard construction as well as their stability over time. Aim 4: To validate the scorecard Methods: The development of the scorecard will employ primary data collection (expert panels and surveys) and analysis of a research level clinical database. A multi-disciplinary mentoring committee whose expertise spans the relevant disciplines of quality assessment and improvement (Drs. Petersen and Kallen) as well as neonatology and health services research (Drs. Gould and Zupancic) will guide the progress of the research agenda. In addition, I have scientific advisors with expertise in neonatology (Dr. Stark), patient safety and survey methodology (Dr. Thomas), and biostatistics (Dr. Pietz). Their mentorship, as well as a focused training and research plan facilitated by a K23 award, will develop my expertise in neonatal quality research by providing crucial content and methodological training. Conclusion: The educational and research agenda are designed to complement my previous training in neonatology and health services research, and will enable me to achieve my goal of developing an independent career in patient-oriented clinical research while furthering the NICHD's mission of ensuring that all children have the chance to achieve their full potential for healthy and productive lives.